Form 4 Mini-Grant APPENDIX B - Application Form

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HELP AMERICA VOTE COLLEGE PROGRAM

SERVICE DAY MINI-GRANT PROGRAM

APPLICATION FOR CONSIDERATION

THIS FORM IS FOR APPLICANTS REQUESTING ACTIVITIES ONLY FOR HELP AMERICA VOTE COLLEGE PROGRAM SERVICE DAY MINI-GRANT PROGRAM. IF YOU PLAN TO REQUEST FUNDING FOR POLL WORKER PROJECT ACTIVITIES, YOU MUST COMPLETE A FULL APPLICATION THROUGH GRANTS.GOV. THIS FORM IS NOT AN ELIGIBLE APPLICATION TYPE FOR APPLICANTS REQUESTING ANY POLL WORKER ACTIVITIES. IF YOU USE THIS FORM TO REQUEST POLL WORKER ACTIVITIES, YOUR APPLICATION WILL BE CONSIDERED INELIGIBLE AND IT WILL BE REJECTED.

Instructions: Complete all sections of this Application Form to apply for the U.S. Election Assistance Commission (EAC) Help America Vote College Program (HAVCP) Service Day Mini-Grant Program. Ensure that information entered in the application narrative sections aligns with information in the budget section. For items in this form with an asterisk – “*” - additional details can be found in the HAVCP Service Day Mini-Grant Application Form Guidance at the end of this document.

Email this completed Application Form to [email protected] with the header “HAVCP Service Day Mini-Grant Program Application – [ORGANIZATION NAME]” by the deadline at 11:59 PM Eastern on XXX.

Section I	Applicant Information
Section II	Executive Summary and Historically Underrepresented Groups
Section III	HAVCP Service Day Mini-Grant Narrative
Section IV	Program Budget
Section V	Financial Capability

Section I. Applicant Information

Entity Name:

Employer Identification Number (EIN/TIN):

Unique Entity ID (UEI)*:

To the best of your knowledge, has your organization ever received funding directly from the U.S. Election Assistance Commission (EAC)?

Yes No

Does your organization serve individuals and/or groups living in an area of persistent poverty and/or a historically disadvantaged community?

Yes No

If yes, please briefly describe:

Does your organization serve individuals and/or groups living in a rural area?

Yes No

If yes, please briefly describe:

Primary Point of Contact

This individual will be contacted with requests for additional information as needed, in addition to receiving notice of an award being offered.

Name:

Title:

Email:

Phone:

Certifying Official

This individual will be responsible for reviewing and agreeing to the terms and conditions of HAVA and the EAC.

Name:

Title:

Email:

Phone:

Section II. Overview and Historically Underrepresented Groups

Service Day Program Activities Planned*:

Help America Vote Day, January 30, 2024 Yes No

National Poll Worker Recruitment Day, August 1, 2024 Yes No

Number of College Students to Be Served by Activities:

This number should reflect how many unique students your organization anticipates directly engaging through Service Day activities, not the student body size.

Amount Requested:

Match Amount (10% Minimum):

Executive Summary:

In the two to five sentences, please provide a brief description of how you plan to utilize HAVCP Service Day Mini-Grant Program funds to elevate civic participation on college campuses and inspire college students to volunteer their time and talents to help others participate in the democratic process as poll workers.

Will your organization/institution/program engage historically underrepresented groups, as defined by the federal government, through your proposed program*?

Yes No

If yes, please describe below how your program will achieve this:

Section III. HAVCP Service Day Mini-Grant Narrative

Narrative*:

The narrative should be no more than three to five paragraphs in length and describe how your organization plans to spend the HAVCP Service Day funds and required matching funds. The narrative should include the amount of your award and matching commitment and the timeframe in which you plan to use the funds.

Section IV. Program Budget

Budget Summary*:

For each Service Day your organization will be hosting activities, please indicate the amount of federal funding, non-federal match funding, and total funding proposed. Please also total the federal and non-federal match amounts for all Service Day activities being requested.

Service Day	Federal	Non-Federal Match	Day Totals
Help America Vote Day
National Poll Worker Recruitment Day
Source Totals

Budget Narrative*:

For each budget category, please list the items required, how it relates to the project, and the estimated cost for each item to meet the proposed project needs. If there are no anticipated costs for a category, please mark it as ‘none’ or ‘N/A.’

Personnel

Fringe Benefits

Equipment

Supplies

Training

Contractual/Consultants

Travel

Other (Describe)

Indirect Costs

Section V. Financial Capability

Does your entity meet all the financial management requirements outlined in 2 CFR 200.302*?

Yes No

If no, please explain:

Which of the following best describes your accounting system:

Manual Automated Combination of manual and automated

Is your entity currently labeled as ‘High Risk’ by a federal agency?

Yes No

If yes, please list federal agency or agencies:

In the space provided, briefly describe organization and personnel experience managing federal grants or similar financial agreements:

HAVCP Service Day Mini-Grant Application Form Guidance

Section I	Applicant Information
Section II	Executive Summary and Historically Underrepresented Groups
Section III	HAVCP Service Day Mini-Grant Narrative
Section IV	Program Budget
Section V	Financial Capability
Section VI	Application Evaluation Criteria

Additional Guidance - Section I. Applicant Information

Unique Entity ID (UEI)*: Per 2 CFR 25.205: “A Federal awarding agency may not make a Federal award … to an applicant or recipient until the entity has … a valid unique entity identifier and maintain[s] an active SAM registration with current information.” Applications will be accepted from organizations without an active UEI; however, the organization must have obtained a valid UEI and active SAM registration by the time of award or they will be disqualified from consideration for an award.

Additional Guidance - Section II. Overview and Historically Underrepresented Groups

Service Day Program Activities Planned: The U.S. Election Assistance Commission does not anticipate award funding to be available prior to Help America Vote Day on January 30, 2024. To address this issue, pre-award costs for Help America Vote Day 2024 may be included as eligible activities, if the costs were incurred after the publication of this funding opportunity package on Grants.gov. If the applicant subsequently receives an award, they may then request to be reimbursed for actual costs incurred hosting Help America Vote Day 2024 activities that would otherwise be allowable under this funding announcement. All pre-award expenses will require approval from the EAC prior to reimbursement. If the applicant does not receive an award, these costs will not be reimbursed by the federal government. The applicant must understand this risk and be able to cover this cost if an award is not made.

Historically underrepresented groups as defined by the federal government: All selection criteria and application quality being equal, EAC will give priority consideration to projects from institutions and organizations that engage historically underrepresented groups, as defined by the federal government, as poll workers.

(a) The term “equity” means the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.

(b) The term “underserved communities” refers to populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social, and civic life, as exemplified by the list in the preceding definition of “equity.”

Additional Guidance - Section III. HAVCP Service Day Mini-Grant Narrative

Narrative: Be sure to indicate if you are requesting funding for activities related to both eligible service days outlined in the Application Kit or only one specific service day.

In your narrative, explain how your program will encourage college students to assist state and local governments in the administration of elections by serving as nonpartisan poll workers or assistants and encourage jurisdictions to utilize these efforts. Be sure to include descriptions of planned partnerships and collaborations, as well as creative or innovative solutions your program will utilize to recruit and engage college poll workers. Also include the number of college students you anticipate serving through the proposed Service Day activities and explain how you arrived at this number.

For more guidance on what information to include and how your responses will be evaluated, refer to Section VI: Application Evaluation Criteria of this guidance and the HAVCP Mini-Grant Application Kit.

Additional Guidance - Section IV. Program Budget

Instructions: The program budget should accurately identify project costs that are reasonable, necessary, and otherwise allowable under federal law and applicable federal cost principles. The budget should describe the expected costs for each specific Service Day, where applicable, and indicate the source of matching funds.

Budget Summary: Example completed summary table:

Service Day	Federal	Non-Federal Match	Day Totals
Help America Vote Day	$3,000	$300	$3,300
National Poll Worker Recruitment Day	$5,000	$500	$5,500
Source Totals	$8,000	$800	$8,800

Budget Narrative:

Examples of eligible activities include but are not limited to:

• Program administration and ramp up activities,

• Partnership Engagement,

• Outreach,

• Recruitment,

• Training,

• Follow-up with students, and

• Supplies and materials.

BUDGET CATEGORY DESCRIPTIONS

These descriptions will help you determine how to allocate expenditures to specific predefined program categories.

Personnel: Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within the applicant organization. In the budget narrative, include a description of the responsibilities and duties of each position in relationship to fulfilling the project goals and objectives. All requested information must be included in the budget detail worksheet and budget narrative.

Fringe Benefits: Fringe benefits should be based on actual known costs or an approved negotiated rate by a Federal agency. If not based on an approved negotiated rate, list the composition of the fringe benefit package. Fringe benefits are for the personnel listed in the budget category (A) and only for the percentage of time devoted to the project. All requested information must be included in the budget detail worksheet and budget narrative.

Travel: Itemize travel expenses of staff personnel (e.g. staff to training, field interviews, advisory group meeting, etc.). Describe the purpose of each travel expenditure in reference to the project objectives. Show the basis of computation (e.g., six people to 3-day training at $X airfare, $X lodging, $X subsistence). In training projects, travel and meals for trainees should be listed separately. Show the number of trainees and the unit costs involved. Identify the location of travel, if known; or if unknown, indicate "location to be determined." Indicate whether applicant's formal written travel policy or the Federal Travel Regulations are followed. Note: Travel expenses for consultants should be included in the “Contractual/Consultant” data fields.

Equipment: List non-expendable items that are to be purchased (Note: Organization's own capitalization policy for classification of equipment should be used). Expendable items should be included in the "Supplies" category. Applicants should analyze the cost benefits of purchasing versus leasing equipment, especially high-cost items and those subject to rapid technological advances. In the budget narrative, explain how the equipment is necessary for the success of the project, and describe the procurement method to be used. All requested information must be included in the budget detail worksheet and budget narrative.

Supplies: List items by type (office supplies, postage, training materials, copy paper, and expendable equipment items costing less than $5,000) and show the basis for computation. Generally, supplies include any materials that are expendable or consumed during the course of the project. All requested information must be included in the budget detail worksheet and budget narrative.

Contractual/Consultant: For each consultant enter the name, if known, service to be provided, hourly or daily fee (8-hour day), and estimated time on the project. All requested information must be included in the budget detail worksheet and budget narrative.

Subgrants (See “Subaward” definition at 2 CFR 200.92): Provide a description of the Federal award activities proposed to be carried out by any subrecipient and an estimate of the cost (include the cost per subrecipient, to the extent known prior to application submission). For each subrecipient, enter the subrecipient entity name, if known.

Other Costs: List items and the basis of the computation. All requested information must be included in the budget detail worksheet and budget narrative.

Indirect Costs: Indirect costs are allowed only if: a) the applicant has a current, federally approved indirect cost rate; or b) the applicant is eligible to use and elects to use the “10% de minimis” indirect cost rate described in 2 C.F.R. 200.414(f). (See paragraph D.1.b. in Appendix VII to Part 200—States and Local Government and Indian Tribe Indirect Cost Proposals for a description of entities that may not elect to use the “de minimis” rate.)

Grantees may recover indirect costs under this grant up to 10 percent of the total Federal share of the grant. If an applicant has an approved federal indirect cost rate, the remainder of the indirect costs can be used as a matching contribution.

An applicant with a current, federally approved indirect cost rate must attach a copy of the rate approval, (a fully executed, negotiated agreement.) If the applicant does not have an approved rate, one can be requested by contacting the applicant’s cognizant Federal agency, which will review all documentation and approve a rate for the applicant organization, or if the applicant’s accounting system permits, costs may be allocated in the direct costs categories. (Applicant Indian tribal governments should review Appendix VII to Part 200—States and Local Government and Indian Tribe Indirect Cost Proposals regarding submission and documentation of indirect cost proposals.) The narrative for any indirect costs should clearly state which direct costs the indirect cost agreement is being applied to. All requested information must be included in the budget detail worksheet and budget narrative.

Additional Guidance - Section V. Financial Capability

Financial Management Requirements: Award recipients are required to have financial management systems and internal controls that meet the requirements set out in 2 CFR 200.302. The financial management system of each non-Federal entity must provide for the following:

(1) Identification, in its accounts, of all Federal awards received and expended and the Federal programs under which they were received. Federal program and Federal award identification must include, as applicable, the Assistance Listings title and number, Federal award identification number and year, name of the Federal agency, and name of the pass-through entity, if any.

(2) Accurate, current, and complete disclosure of the financial results of each Federal award or program.

(3) Records that identify adequately the source and application of funds for federally funded activities. These records must contain information pertaining to Federal awards, authorizations, financial obligations, unobligated balances, assets, expenditures, income and interest and be supported by source documentation.

(4) Effective control over, and accountability for, all funds, property, and other assets. The non-Federal entity must adequately safeguard all assets and assure that they are used solely for authorized purposes. See § 200.303.

(5) Comparison of expenditures with budget amounts for each Federal award.

(6) Written procedures to document the receipt of federal funds and ensure payment methods minimize the time elapsing between the transfer of funds from the United States Treasury and the disbursement by the EAC recipient.

(7) Written procedures for determining the allowability of costs in accordance with subpart E of this part and the terms and conditions of the Federal award.

Application Guidance - Section VI. Application Evaluation Criteria

The EAC has instituted procedures that provide for an objective review of applications and to assist applicants in understanding the standards against which applications will be judged. The evaluation criteria are based on the information required in the application. See APPENDIX D. Scoring Rubric for more detail on how applications will be evaluated and scored. Reviewers will award points based on the evaluation criteria described below:

• Organizational Characteristics (20 Points):

• History of EAC Funding: Organization’s that have not previously received EAC funding will be prioritized.

• Benefit to those in poverty and/or Historically Disadvantaged.

• Benefit to rural areas.

• Program Design and Strategy (5 Points):

• A sound and relevant program that meets the unique needs of the communities served;

• A clear description of how the proposed activities will encourage college students to assist state and local governments in the administration of elections by serving as nonpartisan poll workers or assistants and encourage jurisdictions to utilize these efforts; and,

• The number of targeted college students, including how this number was calculated.

• Budget/Cost Effectiveness (5 Points):

• Cost-effectiveness of the proposed activities in relation to the scope of the project;

• Clarity and completeness of the budget and budget narrative; and,

• Cost sharing identified by the applicant.